Healthcare Provider Details

I. General information

NPI: 1144612516
Provider Name (Legal Business Name): KAITLYN KOTTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST
SAN FRANCISCO CA
94158-2334
US

IV. Provider business mailing address

1500 OWENS ST
SAN FRANCISCO CA
94158-2334
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2808
  • Fax: 415-353-1001
Mailing address:
  • Phone: 415-353-2808
  • Fax: 415-353-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004264
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: